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Surgeon Uses Novel Technique to Repair Child’s Rare Condition

Only the second surgery of its kind, a minimally invasive procedure is a blessing for a little girl and her family.

Of the approximately 500 pediatric surgeons in the United States, only a very small number have ever performed the complex tracheo-esophogeal fistula surgery on a child using a minimally invasive technique.


At Cottage Children’s Hospital in Santa Barbara, Dr. Tamir Keshen – who is board certified in general and pediatric surgery, and specializes in minimally invasive surgery on infants and children – recently performed the procedure on a recurrent fistula. He is only the second physician in the United States – and the only one in the West – to repair this rare problem without having to open the chest.

In recent years, interest in minimally invasive surgery has seen exponential growth in pediatrics, but there are only a handful of qualified pediatric surgeons in the country specializing in advanced pediatric minimally invasive surgery. The benefits of minimally invasive surgery for children include less pain, shorter hospital stays and faster recovery time.

For one parent in Los Angeles, Keshen’s expertise was invaluable – and close to home. Dr. Gil Kryger, who is also a surgeon, was seeking a physician who could help his daughter, Mika, avoid painful surgery.

Mika was born with a rare condition in which there is no direct connection between the mouth and the stomach. When she was just 4 days old, she had surgery to correct the problem.

But 18 months later, the problem recurred in the form of an abnormal connection between the trachea and esophagus. The tracheo-esophageal fistula creates a pathway for food and liquid to go into the lungs, resulting in pneumonia. The recommended surgery involved opening the chest to repair the fistula.

“My wife and I were desperate to find some type of alternative treatment that was less invasive and less painful,” Kryger recalled.

After thorough research, he found a novel technique that was minimally invasive and required that Mika spend only one night in the hospital for observation compared with more than a week in the hospital and intensive care unit.

Kryger discovered that Keshen had previously performed this surgery with success and was now at Cottage Children’s Hospital in Santa Barbara, just a short distance from the Kryger’s home in Los Angeles.

“My wife and I drove up to Santa Barbara to talk in person to Dr. Keshen, and within minutes, we felt at ease for the first time since the problem had been diagnosed,” Kryger said. “Mika underwent surgery on Dec. 26, and our hospital stay was wonderful.”

A recent swallow study conducted in March showed that Mika’s fistula was gone.

“Cottage (Children’s) Hospital’s reputation rivals the quality of care offered by larger academic institutions,” Kryger said.

Keshen says, “To my knowledge, I am the only surgeon in California who performs this type of advanced pediatric minimally invasive surgery.”

“As recently as the mid-‘90s, there were less than a handful of programs specializing in complex, advanced, minimally invasive surgery. At the time, you were almost chastised and it was not well accepted to focus on advanced pediatric minimally invasive surgery,” he added. “I was taught by the best in the field, the forefather, Dr. Keith Georgeson (chief of pediatric surgery, Children’s Hospital of Alabama). And now we, his fellows, are seeing the vast benefits of this type of surgery and are proliferating and teaching it to our own residents and fellows by demand.”

Mia Wasilevich is Big Imagination Group‘s public relations director.

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